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Hepatitis E outbreak linked to water shortages and poor sanitation

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Niamey/Barcelona – An outbreak of hepatitis E in the Diffa region of Niger highlights the water shortages and poor sanitation experienced by displaced people in the region, according to Médecins Sans Frontières (MSF), while calling for authorities and aid organisations to step up their response.

Since December 2016, 135 cases of jaundice have been detected in Diffa. Jaundice, which causes a yellowing of the skin and eyes, is one of the most common symptoms of hepatitis E. Many of these cases were pregnant women admitted to the main mother and child health centre in Diffa town, where MSF works alongside the Ministry of Health; 25 of them subsequently died due to acute liver failure.

Hepatitis E was finally confirmed by laboratory analysis in mid-April and the outbreak was declared by the Nigerien authorities last week. The disease is caused by the hepatitis E virus (HEV) and can lead to liver failure and death, with pregnant women particularly at risk. There is no specific treatment for the disease, which spreads mainly through contaminated water.

“Water and sanitation activities in Diffa are clearly insufficient to meet people’s needs, as we’ve been warning for months,” says Elmounzer Ag Jiddou, MSF’s head of mission in Niger. “MSF is calling on the authorities and all humanitarian organisations working in Diffa to rapidly and significantly increase their response and ensure an adequate water supply and sanitation conditions.”

In recent weeks, MSF teams have been working in coordination with the Ministry of Health to contain the outbreak. MSF has been helping to train health staff and providing resources and extra staff in health centres, hospitals and in the community, in order to detect new cases of the disease as early as possible, refer patients to health facilities and provide them with care. At the same time, MSF teams are conducting awareness campaigns on basic hygiene measures, such as handwashing.

Some 240,000 displaced people and refugees are sheltering in the Diffa region, according to official figures. These people are particularly vulnerable after years suffering the consequences of the conflict between Boko Haram and the armies of the wider region. Of these, some 135,000 have settled in the Kitchendi, Garin Wazan and Toumour areas, where MSF teams are carrying out water and sanitation activities. So far, they have treated 105,700 litres of water to make it safe for drinking. Teams are also distributing water chlorination tablets, soap and new jerrycans to 16,800 families in these locations, and cleaning old jerrycans to make them safe for use and prevent the disease from spreading further.

MSF has been working in Niger’s Diffa region since late 2014. To improve access to healthcare for the local and displaced population, MSF is working alongside the Ministry of Health in the main mother and child health centre in Diffa town, in the district hospital of Nguigmi and at a number of health centres in the districts of Diffa, Nguigmi and Bosso.

In Diffa’s mother and child health centre and in Nguigmi hospital, MSF teams are supporting the reproductive and sexual health and paediatric units and providing mental health support. At Nguigmi hospital, the team is also treating children with severe acute malnutrition. In the health centres, MSF is providing primary and reproductive health consultations and mental health support, as well as carrying out vaccination activities and providing nutritional supplements. MSF teams are also conducting water and sanitation activities, and distributing essential relief items when necessary.